Medicaid Compliance Consultant

This job conducts program management of compliance-related projects conducted by assigned business owners (e.g., compliance analysts, senior compliance analysts, management, etc.) across all states and applicable departments for any type of regulatory requirement that is or may be applicable to the organization, as well as delegation oversight requirements across all applicable regulatory requirements. Maintains subject matter knowledge and expertise to educate and direct business owners on reviewer expectations to support compliance with current, new, and/or revised standards and guidelines. Demonstrates the ability to identify potential business impacts/compliance gaps across the organization and collaborates with and/or directs business owners on the development of solutions to mitigate risk. Reviews documentation developed by business owners to support compliance on an ongoing basis to ensure continuous audit preparedness. Represents the organization with external stakeholders (e.g., CMS, NCQA, BCBSA, state regulatory agencies, etc.) on regulatory requirement related matters. Project management of business owners within department for regulatory compliance-related tasks.

Program Management: Direct business owners and management across the organization on all aspects of regulatory requirements /delegation oversight. From a delegation oversight perspective: determination that delegation exists, agreement language, ongoing monitoring requirements, centralized reporting, and remediation options.

Project Management: Manage department-specific projects to support ongoing compliance with regulatory requirements by: developing and implementing work plans, obtaining status updates, reviewing outcomes, recommending changes (as needed), and working with the applicable business owner on finalization.

Consulting: Provide ongoing direction and support to business owners and management on compliance matters from a reviewer perspective, and coordinate queries to external stakeholders/consultant to resolve complex issues.

Auditing: Review all documents submitted to support compliance with requirements and provide feedback to business owners; coordinate and participate with the internal audit process; develop, implement, and monitor Plans of Correction (as needed); and communicate results to management.

Governance: Chair/facilitate workgroups to ensure that compliance-related matters are reported as required, direction/input is received from applicable subject matter experts, and that adequate documentation is maintained of these discussions; develop/monitor reporting matrices; compile and present reports; and audit documentation.

Special Projects: As assigned by management.

Other duties as assigned or requested.

EDUCATION

Required

Bachelor’s Degree in Finance, Business, Public Policy, Public Administration, Communications, Pre-Law, or Accounting

Substitutions

6 years of relevant work experience

Preferred

Juris Doctorate strongly preferred

Active license in PA and WV

EXPERIENCE

Required

5-10 years of progressive experience in compliance, public policy, government affairs, project management, healthcare operations, law, auditing, or managed care

Preferred

Working knowledge of applicable regulatory standards and guidelines and/or requirements

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

Highmark Health is an independent licensee of the Blue Cross Blue Shield Association

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please call HR Services at 844-242-HR4U(4748) or visit HR Services Online at HRServices@highmarkhealth.org.